SENATE BILL NO. 204

March 04, 2021, Introduced by Senators MCBROOM, MOSS, CHANG, BAYER, WOJNO, IRWIN, ALEXANDER, OUTMAN, BRINKS, POLEHANKI, SANTANA and GEISS and referred to the Committee on Health Policy and Human Services.

A bill to amend 1978 PA 368, entitled

"Public health code,"

(MCL 333.1101 to 333.25211) by adding section 21525.

the people of the state of michigan enact:

Sec. 21525. (1) A hospital shall provide sufficient and qualified registered professional nursing staff at all times to ensure patient safety.

(2) Not later than 3 years after the effective date of the amendatory act that added this section, or not later than 4 years if a hospital is located in a rural area, a hospital shall develop and implement a staffing plan as provided under this section. Within the applicable time period prescribed in this subsection and annually after that, a hospital shall submit its staffing plan to the department.

(3) To assist in the development of a staffing plan, a hospital shall establish a staffing committee for each unit within the hospital and not less than 1/2 of the members must be registered professional nurses who are direct care providers in that unit. If the nurses in the hospital are under a collective bargaining agreement, the collective bargaining representative shall designate the nurses from within each unit to serve on the staffing committee for that unit. Participation on the staffing committee is considered part of the nurse's regularly scheduled workweek. A hospital shall not retaliate against a nurse who participates on the staffing committee. The staffing committee shall establish a staffing strategy for that unit if the patients' needs within that unit for a shift exceed the required minimum direct care registered professional nurse-to-patient ratios set forth in subsection (4).

(4) A hospital's staffing plan must not assign more patients per direct care registered professional nurse than indicated by the following direct care registered professional nurse-to-patient ratios for each of the corresponding units:

(a) Intensive/critical care: 1 to 1.

(b) Operating room: 1 to 1, if not less than 1 additional individual serves as a scrub assistant in the unit.

(c) Labor and delivery:

(i) During second and third stages of labor: 1 to 1.

(ii) During first stage of labor: 1 to 2.

(iii) Intermediate care newborn nursery: 1 to 3.

(iv) Noncritical antepartum patients: 1 to 4.

(v) Postpartum mother baby couplet: 1 to 3.

(vi) Postpartum mother or well-baby care: 1 to 6.

(d) Postanesthesia care unit: 1 to 2.

(e) Emergency department:

(i) Nontrauma or noncritical care: 1 to 3.

(ii) Trauma or critical care: 1 to 1.

(iii) Plus 1 R.N. for triage.

(f) Stepdown: 1 to 3.

(g) Telemetry: 1 to 3.

(h) Medical/surgical: 1 to 4.

(i) Pediatrics: 1 to 4.

(j) Behavioral health: 1 to 4.

(k) Rehabilitation care: 1 to 5.

(5) If a unit that is not listed in subsection (4) provides a level of care to patients whose needs are similar to the needs of patients cared for in a unit that is listed in subsection (4), a hospital shall apply the minimum direct care registered professional nurse-to-patient ratio for the unit that is listed in subsection (4) to the unit that is not listed.

(6) The minimum direct care registered professional nurse-to-patient ratios required under subsection (4) must be in effect at all times, including during breaks, meals, and other routine, expected absences from a unit.

(7) A hospital shall not do any of the following:

(a) In computing the minimum direct care r